MaineMOM MaineMOM Model of Care for Perinatal Patients Model of - PDF document

9/30/2020 MaineMOM MaineMOM Model of Care for Perinatal Patients Model of Care for Perinatal Patients with Opioid Use Disorder with Opioid Use Disorder August 28, 2020 Alane O’Connor DNP 1 Disclosure I do not have any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of this continuing education program. Maine Department of Health and Human Services 2 2 1

9/30/2020 MaineMOM Overview • Five year funded initiative with Center Medicare and Medicaid Innovation (CMMI) from January 2020 - December 2024 • Designing a MaineCare care-delivery system for pregnant and post-partum patients with OUD with the aim to increase care integration, improve outcomes, and reduce costs • MaineMOM integrated services to be tested in July 2021 at sites across Maine with the following partners: • MaineGeneral • MaineHealth • MidCoast Hospital • Northern Light • Penobscot Community Health Center • Pines Health Services Maine Department of Health and Human Services 3 3 MaineMOM Timeline • January 2020 – June 2021 (Year 1): Plan and Design Services • Implement advisory structure to garner input and feedback from healthcare providers, community programs, and women in recovery • Launch educational support and public outreach and awareness campaign • July 2021 – June 2022 (Year 2): Test and Implement MaineCare Policy • Implement MaineMOM Services with six partner organizations to test and improve services • Incorporate MaineMOM services into the MaineCare Benefits Manual • July 2022 – June 2023 (Year 3): Expand Services • Open expansion to other healthcare sites to deliver MaineMOM services • July 2023 – July 2024 (Year 4): Improve Services • July 2024 – June 2025 (Year 5): Evaluate Outcomes Maine Department of Health and Human Services 4 4 2

9/30/2020 Why Maine? • Maine is one of the states hardest hit by the opioid epidemic, averaging almost one opioid related death per day over 2017 and 2018 1 • In 2019, 7% of Maine’s births were substance exposed 2 1. https://www.drugabuse.gov/drug ‐ topics/opioids/opioid ‐ summaries ‐ by ‐ state/maine ‐ opioid ‐ involved ‐ deaths ‐ related ‐ harms 2. Office of Child and Family Services, Maine DHHS. (2020) Drug Affected Baby/Substance Exposed Newborn Referrals Calendar Year 2019 Summary. Maine Department of Health and Human Services 5 5 MaineMOM Objectives • “No wrong door" screening, welcoming, and engaging women in care • Supporting treatment and recovery of mothers with group-based Medication Assisted Treatment (MAT) • Increasing the capacity of integrated teams to deliver evidence-based care, including through telehealth • Coordinating care across the system and within the community • Conducting a public outreach campaign aimed at increasing awareness of treatment and reducing stigma Maine Department of Health and Human Services 6 6 3

9/30/2020 MaineMOM Key Services 7 Maine Department of Health and Human Services 7 Enrolling in MaineMOM Services • Services will begin July 2021 with a “No wrong door” approach o Media campaign to direct women to Maine’s CradleME referral system. Campaign will also focus on reducing stigma around substance use during pregnancy. o CradleME Referral System will be enhanced – additional staff to provide warm handoff to MaineMOM providers. o MaineMOM encourages “medication first” approach. Critical to collaborate with EDs as patients might first present there for induction onto buprenorphine. o Collaboration and coordination with services across Maine DHHS o Public Health Nursing, Maine Families, WIC, Recovery Residences, Opioid Treatment Providers 8 Maine Department of Health and Human Services 8 4

9/30/2020 MaineMOM Educational Support • Focus on clinical education through: • Clinical office hours for collaboration and consultation • MaineMOM Statewide ECHO • A virtual learning structure • Utilize expert faculty to provide focused case consultation and support for implementation of quality care practices Maine Department of Health and Human Services 9 9 CradleME Referral System http://cradleme.org/ Maine Department of Health and Human Services 10 10 5

9/30/2020 MaineMOM Contacts Program Manager Liz Remillard, MPH, Liz.remillard@maine.gov Clinical Advisor Alane O’Connor, DNP, Alane.oconnor@maine.gov Program Coordinator Rachel McLean, Rachel.mclean@maine.gov MaineMOM Webpage https://www.maine.gov/dhhs/oms/about ‐ us/projects ‐ initiatives/maine ‐ maternal ‐ opioid ‐ model This program is managed by the Office of MaineCare Services Value-Based Purchasing Unit and funded by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS). Maine Department of Health and Human Services 11 11 Infant Plan of Safe Care Infant Plan of Safe Care • Collaborative effort between Maine CDC, DHHS, clinician experts and others. ME CDC recently hired plan of safe care nurse. • Coming short term – likely October 2020 – a version that will be completed by OCFS in collaboration with care providers for substance exposed infants. • Coming long term – a version that will be initiated by prenatal providers that will follow the infant through birth and beyond. For ALL infants, not just those substance exposed. • Questions: dara.fruchter@maine.gov Maine Department of Health and Human Services 12 12 6

9/30/2020 Supporting Substance Exposed Infants Supporting Substance Exposed Infants and Their Families with the Attachment and and Their Families with the Attachment and Biobehavioral Catch-up (A BC) Intervention Biobehavioral Catch-up (A BC) Intervention PRESENTED BY: Alane O’Connor DNP PRESENTED BY: Alane O’Connor DNP 1 3 13 Substance exposed pregnancies Substance exposed pregnancies • Pregnant women with substance use disorder are likely to have: – an unplanned pregnancy; – many adverse childhood experiences, ACE’s (a “dose response” relationship); – a co-occurring mental health disorder; – more than one substance use disorder (opioid, nicotine, alcohol, stimulants, cannabis); – experienced (past and/or present) intimate partner violence; – difficulty developing healthy attachments in relationships (fear, low self-esteem, and unstable, volatile and unpredictable relationships). Maine Department of Health and Human Services 14 14 7

9/30/2020 Substance exposed infants Substance exposed infants • Infants exposed to opioids during pregnancy are at risk of neonatal abstinence syndrome (e.g., irritability, tremor, poor feeding, crying, difficulty being consoled). Mom often feels shame, “this is my fault.” • May experience disruptions in care (1/2 of all child removals in Maine are related to substance use). • For successful attachments to occur, mom and infant need to learn to read and respond to each other’s cues. Maine Department of Health and Human Services 15 15 What is ABC? What is ABC? • Developed by University of Delaware, Mary Dozier, Ph.D. • For infants and young children (6-24 months) who have experienced early adversity and may push caregivers away. • Three targets: – Nurturance when a child is distressed; – Following the lead with delight (responsive, predictable, warm environment); – Avoiding frightening/intrusive behavior • All of these targets are thought to improve attachment quality and develop early self-regulation. • Our ABC program only one north of NYC; only one in the world focusing exclusively on moms with opioid use disorder. 16 Maine Department of Health and Human Services 16 8

9/30/2020 What are the outcomes associated with ABC? What are the outcomes associated with ABC? • Children: – are more likely to be securely attached to their caregivers; – develop more normative stress hormone patterns; – develop better impulse control; – are less likely to show anger during a challenging task; – have an easier time switching between complex tasks (executive functioning); – have more advanced receptive language abilities. • Parents respond to their young children with more sensitivity. Maine Department of Health and Human Services 17 17 Overview of ABC Overview of ABC • 10-session intervention • Delivered in the home • Primary caregiver(s) and child involved – Other caregivers, siblings welcome too • Manualized intervention: 2 components – In the moment (ITM) commenting • “Real-time” feedback delivered by providers (i.e., parent coaches) • Goal: frequent, descriptive, on-target feedback – Session-by-session content 18 18 9

9/30/2020 Example of ITM comments (Nurturance) Example of ITM comments (Nurturance) • “When she fell down you went right over to her and picked her up.” ( describing the behavior ) • “That’s a great example of you nurturing her.” ( labeling the ABC target ) • “She will not only develop trust in you, but also in others.” ( providing a research-backed outcome ) 19 19 Manualized content: session overview Manualized content: session overview 1 ‐ 2 Providing nurturance 3 ‐ 4 Following the lead with delight 5 ‐ 6 Avoiding intrusive and frightening behavior 7 ‐ 8 Recognizing own issues (“Voices from the Past”) 9 ‐ 10 Consolidating gains and celebrating change 20 20 10